What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?   

The patient has no personal history of VTE, but has positive family history of VTE. 

Any prophylactic anticoagulation options?

How would management change if it is homozygous vs heterozygous prothrombin mutation? 



Answer from: at Academic Institution
Comments
at MedStar Georgetown University Hospital
Interestingly, in this cohort, one transgender fem...
Medical Oncologist at Einstein Healthcare Network
I would suggest to use the lowest dose of estrogen...
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